The Case for a More Holistic Approach to Dry Eye Disease: Is It Time to Move beyond Antibiotics?

Abstract

Dry eye disease (DED) is one of the most frequent presentations to optometrists with over 16 million US adults (6.8% of adult population) diagnosed as having this disorder. The majority of associated marketed products offer relief from symptomatology but do not address aetiology. DED harbours many distinguishing features of a chronic inflammatory disorder. The recent explosion in human microbiome research has sparked interest in the ocular microbiome and its role in the preservation and extension of ocular surface health and in the contribution of the gut microbiome to chronic systemic inflammation and associated “Western life-style” diseases. With a significant lack of success for many patients using currently available DED treatments, in this era of the microbiome, we are interested in exploring potential novel therapies that aim to reconstitute healthy bacterial communities both locally and distally (in the gut) as a treatment for DED. Although this direction of investigation is in its infancy, burgeoning interest makes such a review timely. This paper considers a number of studies into the use functional foods and associated products to ameliorate dry eye.

An insight on the eye bacterial microbiota and its role on dry eye disease

“…Graham et al [35] example includes the macrolides which present an anti-inflammatory activity similar to tetracyclines [6]. The suppression of the immune system by these antibiotics, such as tacrolimus, is achieved by the inhibition of cytokine release [15].…”

“…Dry eye disease (DED) is a multifactorial disorder of the ocular surface [1] produced mainly by a lower tear quality or quantity needed for protection and better functioning [2]. Due to its high prevalence, varying from 5-34% worldwide to 75% with 40 years and older, along with its complexity and the increasing impact in quality of life [2][3][4], DED has been widely investigated regarding diagnostic and therapeutic approaches [5,6]. Nevertheless, its etiology and pathophysiology are still not fully understood [6].…”

“…Due to its high prevalence, varying from 5-34% worldwide to 75% with 40 years and older, along with its complexity and the increasing impact in quality of life [2][3][4], DED has been widely investigated regarding diagnostic and therapeutic approaches [5,6]. Nevertheless, its etiology and pathophysiology are still not fully understood [6]. Specifically, DED is characterized by a loss of homeostasis of the tear film which leads to a hyperosmolarity (340 mosm/L) and the subsequent activation of inflammatory events resulting in the damage of the epithelial cells of the ocular surface [3,5,7].…”

Epidemiology, Microbiology, and Genetics of Contact Lens–Related and Non–Contact Lens-Related Infectious Keratitis

“…The presence and type of the ocular surface microbiome influence susceptibility to and the severity of sterile corneal infiltrates in CL wearers, 45 marginal keratitis 46 and S. aureus corneal infections in non-CL wearers. 47 Given the protective effects of the gut microbiota in dry eye disease, 48 there may be a level and constitution of either or both the gut and ocular surface microbiome that is protective against keratitis, notwithstanding the low numbers of culturable organisms normally present at the ocular surface. 49 A detrimental effect of CL wear on the ocular surface microbiome could conceivably contribute to an increased risk of infectious keratitis in CL wearers.…”

Review of Loteprednol Etabonate 0.5%/Tobramycin 0.3% in the Treatment of Blepharokeratoconjunctivitis

“…There are many ocular inflammatory conditions for which corticosteroid therapy is indicated and there exists a risk of superficial bacterial infection [1], such as ocular surface infections and certain inflammatory diseases, superficial ocular diseases, and some forms of conjunctivitis [1][2][3][4][5]. Corticosteroid/antibiotic combination products are often used to treat these types of conditions [1].…”